COPD – PBL 8

Hypercapnia (  CO 2 )Hypoxia (  O 2 ) HyperventilationDyspnoea AsterixisHeadaches/fatigue Flushed skinCynosis Disturbed sleepTachapneoa Nausea, vomiting Increased Blood Pressure (polycythaemia) Systemic hypotension or hypertension depending on the underlying diagnosis Arrhythmias? Wheezing, hyperinflation (ie, barrel chest), decreased breath sounds, hyperresonance on percussion, and prolonged expiration Disorientation Delirium Convulsions UnconsiousnessChanges in conciousness

 Chest X-ray  Spirometry: diagnosis of obstructive lung disease and for assessment of the severity of disease  Serum chemistries: compensatory increase in serum bicarbonate concentration?  FBE: also hypoxemic? secondary polycythemia?  Drug screens: opiates, barbiturates, and benzodiazepines?  CT

 Beta-agonists (short and long):act on the beta 2 - adrenergic receptor, causing smooth muscle relaxation, resulting in dilation of bronchial passages (eg, albuterol, salmeterol)  Anticholinergic agents: cause airway smooth muscles to relax by blocking stimulation from cholinergic nerves (ipratropium)  Corticosteroids: act to reduce inflammation in the airways, in theory reducing lung damage and airway narrowing caused by inflammation. Do not provide immediate relief of symptoms more for treating/preventing acute exacerbations of COPD (prednisone, fluticasone)

 COPD with an FEV 1 of less than 1.5 L.  A P a O 2 on air of less than 7.3 kPa (55 mmHg) with or without hypercapnia. Measurements should be taken on two occasions at least 3 weeks apart after appropriate bronchodilator therapy.  Oxygen is most commonly delivered to the patient via a nasal cannula or mask attached to the tubing. The nasal cannula is usually the delivery device of choice since it is well tolerated and doesn't interfere with the patient's ability to communicate, eat, or drink.  88% - 92% sats achieved

 Chest physiotherapy  Nutrition: Underweight/overweight?  Cold Air: bronchospasm and increased breathlessness  Surgery: a) Bullectomy - surgical removal of a bulla, a large air-filled space that can squash the surrounding, more normal lung; b) Lung volume reduction surgery - parts of the lung that are particularly damaged by emphysema are removed; c) Lung transplantation is sometimes performed for severe COPD, particularly in younger individuals.  STOP SMOKING

 process of forcing air into the lungs of a patient, usually using a bag valve mask (BVM) or mechanical ventilator  Works by forcing air into the lungs and thereby increasing the pressure inside the airway relative to the outside  Endotracheal tube or tracheostomy tube

 Administration of ventilatory support without using an invasive artificial airway (endotracheal tube or tracheostomy tube) - best current technique uses tight-fitting facial masks to deliver bilevel positive airway pressure ventilatory support (BiPAP)  Similar reductions in diaphragm energy expenditure and improvements in arterial blood gas levels  Cheaper  Lower mortality rates  Lower complications  Lower length of ICU care  Lower nursing care COPD: Journal of Chronic Obstructive Pulmonary Disease 2009, Vol. 6, No. 3, Pages , DOI / Non-Invasive Ventilation (NIV) in the Clinical Management of Acute COPD in 233 UK Hospitals: Results from the RCP/BTS 2003 National COPD Audit